Providing dignity therapy to patients with advanced cancer: a feasibility study within the setting of a hospital palliative care unit

Francesca Nunziante,Elena Turola,Luciano Masini,Luca Braglia,Silvia Tanzi,Silvia Di Leo,Davide Simonazzi,Elisabetta Bertocchi,Matilde Dragani,Cristina Autelitano,Enrica Bedeschi,Sara Alquati

doi:10.1186/s12904-021-00821-3

Abstract

BackgroundDignity is a basic principle of palliative care and is intrinsic in the daily practice of professionals assisting individuals with incurable diseases. Dignity Therapy (DT) is a short-term intervention aimed at improving the sense of purpose, meaning and self-worth and at reducing the existential distress of patients facing advanced illness. Few studies have examined how DT works in countries of non-Anglo Saxon culture and in different real-life settings. Moreover, most studies do not provide detailed information on how DT is conducted, limiting a reliable assessment of DT protocol application and of its evaluation procedure.The aim of this study was to assess the feasibility and acceptability of a nurse-led DT intervention in advanced cancer patients receiving palliative care.MethodThis is a mixed-method study using before and after evaluation and semistructured interviews. Cancer patients referred to a hospital palliative care unit were recruited and provided with DT. The duration of sessions, and timeframes concerning each step of the study, were recorded, and descriptive statistical analyses were performed.The patients' dignity-related distress and feedback toward the intervention were assessed through the Patient Dignity Inventory and the Dignity Therapy Patient Feedback Questionnaire, respectively. Three nurses were interviewed on their experience in delivering the intervention, and the data were analyzed qualitatively.ResultsA total of 37/50 patients were enrolled (74.0%), of whom 28 (75.7%) completed the assessment. In 76.7% of cases, patients completed the intervention in the time limit scheduled in the study. No statistically significant reduction in the Patient Dignity Inventory scores was observed at the end of the intervention; most patients found DT to be helpful and satisfactory. Building opportunities for personal growth and providing holistic care emerged among the facilitators to DT implementation. Nurses also highlighted too great of a time commitment and a difficult collaboration with ward colleagues among the barriers.ConclusionsOur findings strongly support the acceptability, but only partially support the feasibility, of nurse-led DT in advanced cancer patients in a hospital setting. Further research is needed on how to transfer the potential benefits of DT into clinical practice.Trial registrationRetrospectively registered on ClinicalTrial.gov NCT04738305.

Highlights

Dignity is a basic principle of palliative care and is intrinsic in the daily practice of professionals assisting individuals with incurable diseases
No statistically significant reduction in the Patient Dignity Inventory scores was observed at the end of the intervention; most patients found Dignity Therapy (DT) to be helpful and satisfactory
Building opportunities for personal growth and providing holistic care emerged among the facilitators to DT implementation

Summary

Introduction

Dignity is a basic principle of palliative care and is intrinsic in the daily practice of professionals assisting individuals with incurable diseases. Dignity Therapy (DT) is a short-term intervention aimed at improving the sense of purpose, meaning and self-worth and at reducing the existential distress of patients facing advanced illness. First described by Chochinov in 2002 [1] as a shortterm intervention aimed at reducing psycho-emotional and existential distress and improving the sense of personhood, purpose, meaning and self-worth of patients facing advanced illness, Dignity Therapy (DT) engages individuals in a contemplation of their life experience and the aspects that they consider most important and that they wish to share. The multifaceted aspects of dignity are broadly classified into three categories, namely, intrinsic dignity, subjective dignity, and relational dignity [7] Each of these definitions has its own limits, and none alone can be an exhaustive premise for nurturing both the bioethical debate and clinical practice, especially with reference to palliative care. Current evidence suggests the need to investigate how DT can comprehensively work in different cultural contexts and real-life settings, to discover the time and resource commitments required to deliver DT and to explore the experience of professionals delivering it [9, 19,20,21,22,23,24]

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